… is from page 83 of David Kelley’s excellent 1998 volume, A Life of One’s Own: Individual Rights and the Welfare State:
Obtaining treatment for illness or injury is obviously a human need, but hardly a more important need than obtaining food or shelter. As with all other goals, people need the freedom to weigh it against other goals and to choose the means of obtaining it. But they cannot define their freedom in defiance of the facts, or at the expense of the freedom of others. Illness and injury are natural risks inherent in life, and all the means of dealing with them – from aspirin, to open-heart surgery, to health maintenance organizations – must be produced by human effort to which no one can have a right without the producers’ consent.
The reality is clear and obvious when we peer behind the veil of money and past the cloud of confusion introduced by taxation, subsidies, command-and-control diktats, and legions of bureaucrats: no one can exercise a right to receive health care without simultaneously denying to other people the right to use their labor as they choose. If I have a right to have my hernia repaired at some price lower than what is necessary to persuade a surgeon to perform such a repair voluntarily, then for me to exercise that right is for me to force that surgeon to repair my hernia on terms that he or she deems unacceptable. My exercise of such a ‘right’ enslaves for a time another human being. That other human being is forced to work for me on terms that he or she would not choose voluntarily.
The surgeon repairs my hernia not because by doing so he and I both enjoy mutual gains from trade; no – he repairs my hernia only because, should he refuse to do so, he will be punished for failing to supply to me a service that I refuse to pay full price to receive.
Ditto for me to exercise a ‘right’ to obtain bandages, aspirin, dental care, pediatric care for my children, psychiatric counseling, you name it: my ‘positive right’ to medical care is a faux-friendly term for my privilege to force others to labor for me.
If you think that this claim is over-the-top, imagine a small village in which there is only one physician (Dr. Smith). The dozen other citizens of this village are deemed by a feudal overlord to have a ‘positive right’ to health care. Whenever farmer Jones has an ache, pain, or insomnia, the overlord’s thugs force Dr. Smith to attend to Jones’s ailments. Whenever seamstress Williams is ready to give birth, the overlord’s thugs oblige Dr. Smith to deliver the child and to give Ms. Williams appropriate postpartum care. When Ms. Williams’s husband, the village blacksmith, has a heart attack, the overlord’s thugs force Dr. Smith to do all that he can to save the blacksmith’s life.
You might regard the overlord’s policy of providing health care to his village subjects as humane and wise. And you might even make a sound, fact-based case that this policy results in better health-care outcomes for the villagers so fortunate to live in such a “Progressive” hamlet. (Perhaps Dr. Smith is unusually unresponsive to the material incentives that motivate the great bulk of humanity – incentives that, for example, prompt people to consume fewer health-care services the higher is the price to them individually of consuming health-care services.) Regardless. In this village, Dr. Smith – while not a chattel slave to anyone – is forced to work for others not on terms mutually agreeable but, instead, on terms dictated by the overlord. The value of Dr. Smith’s labor is forcibly transferred from him to others, without his consent. That Dr. Smith’s forced losses might be insufficient to cause him to move to another village does not mean that he is not regularly, if on each occasion only temporarily, enslaved to work for others and in ways against his own interest.
What’s true of Dr. Smith in this hypothetical hamlet is true of all health-care suppliers in large societies such as the United States. That the size and complexity of our economy masks the reality that ‘positive rights’ cannot be exercised successfully without the simultaneous extraction of forced labor from others doesn’t in the least make this reality any less real or less morally offensive.